Healthcare Provider Details

I. General information

NPI: 1912006529
Provider Name (Legal Business Name): STUART ISSLEIB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S MICHIGAN AVE
CHICAGO IL
60616-2333
US

IV. Provider business mailing address

777 OAKMONT LN SUITE 1600
WESTMONT IL
60559-5511
US

V. Phone/Fax

Practice location:
  • Phone: 312-567-5653
  • Fax: 312-328-7986
Mailing address:
  • Phone: 630-789-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: STUART A ISSLEIB
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 312-567-5653